A 65-year-old lady presented with difficulty in climbing stairs, difficulty in getting up from squatting posture for last 2-3 month numbers and weakness of both lower limbs and upper limbs, feelings heaviness of tongue for 2 months subacute onset and slow progression over last 6 weeks, however, no difficulty in swallowing and respiratory distress. She is not a known HTN or diabetic, non-smoker and social drinker, not on any drugs, affluent economic status mostly vegetarian and no history of any neuromuscular disorder in her family.
The exam reveale d mildly anemic, b/l pedal edema with some pigmentation over both ankles, no other visualised neurocutaneous markers are seen no nail changes BP 110/80, pulse 80/min regular and no postural drop of BP. Her higher mental function and cranial nerve exam normal except little bulky and pigmented tongue, motor exam proximal muscle power 4+/5 upper…
